Issue #3: The Latest in Critical Care, 6/5/23

Jun 05, 2023

∙ Paid

Corticosteroids for community-acquired pneumonia (CAPE COD trial)

May 11

Corticosteroids for community-acquired pneumonia have been studied with inconclusive results, and expert guidelines currently advise against their use except in patients with refractory septic shock. Only a few trials have tested the utility of steroids for pneumonia in ICU patients; one of the largest and most recent ones enrolling 586 patients at U.S. veterans’ hospitals

Read full story

Etomidate as an induction agent increases mortality in critically ill patients?

PulmCCM

May 11

Etomidate is a widely-used agent in rapid sequence induction for endotracheal intubation in critically ill patients. It’s also known to cause adrenal suppression, but the clinical significance of this side effect has never been definitively established. Numerous randomized trials have raised suspicion but failed to prove harm caused by etomidate.

Read full story

ECMO vs CPR for pre-hospital resuscitation after cardiac arrest (INCEPTION trial)

PulmCCM

May 11

They really go the extra mile in the Netherlands. One hundred sixty patients who could not regain spontaneous circulation after 15 minutes of CPR following out-of-hospital cardiac arrest with ventricular arrhythmias (“shockable rhythms”) were randomized to be cannulated to undergo extracorporeal membrane oxygenation (ECMO), or receive continued advanced cardiac life support (ACLS) without ECMO. There was no significant difference in survival with a favorable neurologic outcome at 30 days (20% vs 16% nominally favoring the ECMO group, P=0.52) or at 6 months.

Read full story

Aspiration vs tube thoracostomy for primary spontaneous pneumothorax

PulmCCM

May 11

In the U.S., large pneumothoraces are generally treated with tube thoracostomy (chest tube drainage); in Europe, it’s common to first attempt to simply aspirate the pleural space (such as with a thoracentesis kit) — it’s often successful at resolving the pneumothorax, and is less invasive. Among 402 patients with primary spontaneous pneumothorax at 31 French hospitals, 71% of those randomized to aspiration had lung expansion 24 hours later, vs 82% of those receiving chest tube drainage. Those undergoing aspiration had less pain and only a minority eventually required chest tube drainage. Patients with secondary pneumothoraces (e.g., iatrogenic or hospital-acquired) were excluded.

Read full story

In The News

The Hospitalist and the Resuscitationist 2023 Conference will take place September 27-30 in Montreal. Check out the preliminary program, and use code PULMCCM15 to get 15% off the attendance fees. Register today for H&R 2023

Sucralose disrupts DNA in in vitro cell cultures, and is linked to leaky gut syndrome, according to researchers publishin…

Keep reading with a 7-day free trial

Subscribe to PulmCCM to keep reading this post and get 7 days of free access to the full post archives.